Justin Doherty, Medicare Insurance Broker

Answer: If you are already receiving Social Security, you will be enrolled automatically. For those not yet receiving Social Security, you may apply for Medicare once you are within 3 months of your birth month.

Answer: The Annual Enrollment Period runs from Oct 15th - Dec 7th. During this time, you can change MA plans, enroll in MA plans, or disenroll from Medicare Advantage plans. You can also change, enroll in, or disenroll from Drug (Part D) plans.

The Medicare Advantage Open Enrollment Period runs from Jan 1st - Mar 31st. For anyone already enrolled in an MA plan, you may change to another MA plan or return to Original Medicare (and apply for a Medicare Supplement plan) and enroll in a Part D (drug) plan.

Special Enrollment plans are available throughout the year for various situations, such as moving, losing other coverage, enrolling in/disenrolling from/receiving Medicaid or other assistance programs.

Answer: Sadly, there are so many "ins-and-outs" where Medicare is concerned, it's hard to adequately communicate everything to the public. This is why it is so important to find a good, trusted agent to help provide this information to you.

Answer: Extra Help is a program available by contacting Social Security. If you meet specific income and resource requirements, you may be approved for lower prescription deductibles and copays.

Answer: Medicare Advantage plans are required to have a minimum number of providers and facilities that are in their network. Rural areas make this a struggle, so you may find fewer plan options available to you.

Answer: You'll need to evaluate how you want your coverage to work. If you want more comprehensive coverage that allows access to the most providers and least amount of hassle when obtaining services, a Medicare Supplement policy is a great option. For those that don't mind those types of hassles and want a lower monthly premium for their plan(s), Medicare Advantage plans are a good option.

Answer: Sadly, unless you're dealing with a good agent that cares more about his clients than his commission, you are your best advocate. Some agents, whether independent or captive to a specific company, are only concerned with getting someone to sign up. While they should care enough about the person to share all of the important details of the plan, they shortcut things to "get a sale" and leave those types of details out of the conversation.

Answer: Deductibles must be paid before your plan will pay for certain services. During this stage, you pay 100% of the allowed amount.

Copays are the amount you pay per service in addition to the amount paid by the plan.

Answer: If you have a Medicare Supplement plan, you might have a limited foreign travel benefit. For people on Medicare Advantage plans, you will have emergency coverage while traveling abroad. However, you may not have coverage beyond the emergency. Regardless of your Medicare coverage, I always recommend a Travel Insurance policy. This option provides a limited period of coverage that will make sure you're protected while traveling outside the U.S.

Answer: If you have a Medicare supplement plan, you'll want to prepare for your premiums to increase each year. Those amount will vary, but it's good to expect at least a 10% increase every year. For anyone on a Medicare Advantage plan, you should prepare for increased out-of-pocket costs. As your health declines, you'll likely experience more co-pays (and possibly coinsurance). The amount of those copays will likely increase year after year.

Answer: Yes, these are covered by Medicare. There is a "schedule" for what services you may receive and when you may receive them. You can always contact Medicare directly if you need to know any specific details for what is available and when.

Answer: Resources don't affect your Drug plan. Technically, discount cards don't either. That's because you cannot use both a discount card and your drug plan at the same time. When paying for a medication, you can use EITHER your plan or discount card, whichever one provides you with the lowest copay.

Answer: Unfortunately, you won't likely be able to get a Medicare Supplement policy. However, you will have the option to enroll in a Medicare Advantage plan each year during the Annual Enrollment Period (or through a Special Enrollment Period if you qualify for one). This AEP runs from October 15th through December 7th each year.

Answer: Yes and No. They have the ability to offer these incentives which is a good way for some seniors to get a few extra bucks. However, it is also a chance for companies to increase their enrollment even if their plans are not the best fit for their enrollees. Medicare Advantage plans can be very profitable for companies, so it makes sense that they want to increase their enrollment through various methods. That's why it is so important for seniors to review the plan benefits and make sure the plan will actually fit their needs.

Answer: If you do not have other "credible" coverage, you should still enroll in Medicare. Since you won't be receiving for Social Security, you will need to submit an application for Medicare Parts A & B. This can be done, in-person or over-the-phone with your local SS office. You may also mail a paper application, or apply online by visiting Social Security's website www.ssa.gov.

Answer: You will not receive the full amounts for both of you. Generally, the total amount you receive will be the amount of the highest benefit. For example, if you receive $500 per month and your husband made $750, you will receive $750. The way SSA breaks that down is by continuing to pay you your own benefit of $500 and an additional $250 of your husband's benefit. In a situation where you received more than your husband, your benefit would remain the same.

Answer: During the Annual Enrollment Period, you will be able to review your options, choose the plan that best fits your goals/needs, and enroll in that plan. Contacting a good agent will help you weed through that process much faster and more efficiently than trying to do it on your own.

Answer: Over the counter benefits and dental/vision services. When looking at the out-of-pocket costs related to your medical services, most people have a greater expense than if they would just pay cash for those services and items.

Answer: Life insurance is a great way to preserve and pass on your wealth. There are tax advantages for this in addition to the obvious financial advantages. Term insurance is great for covering debt and lost income. Also, having a plan in place to cover your final expenses is often the cheapest way to plan for those expenses.

Answer: The only advantage is the ability to meet in person with the agent. While I understand the desire to do that, you will still have all the other benefits of working with an agent remotely. And the remote agent may be a better fit ethically and professionally than your local agent.

Answer: You're better off comparing your options. Medicare Supplement policies combined with drug plans are more comprehensive. Alternatively, you could choose a low premium Medicare Advantage plan that includes drug coverage and add a couple indemnity plans to offset your out-of-pocket risk. This would likely cover the services you'd be most concerned with and provide a lower monthly cost than the supplement option. A thorough comparison is going to be your best bet!

Answer: Sadly, the answer to this question is BOTH. Your doctor will primarily decide. However, he will have to stay within the parameters of what your insurance company will cover. For anything outside the normal parameters, he will have to "fight" for you by submitting additional requests and documentation to get the insurance company to approve certain services.

Answer: This question no longer applies as we're into September of 2025. That being said, there have been significant changes to drug coverage due to the removal of the donut hole.

Answer: Typically, the only disadvantage I see with an HMO is the network restrictions. There is NO out-of-network coverage with an HMO, so you have to be very careful to only use providers that accept your plan. Additionally, you might have to worry about seeing your PCP to get referrals to specialists before you can schedule those visits.

Answer: Your Medicare will start automatically once you have received SSDI for 24 months. Enrollment is automatic, so you just need to watch the mail for any letters from Social Security as well as your Medicare card.

Answer: Personally, I think Medicare coverage of these services would increase the cost of Medicare for everyone. In addition, I think it would make it tougher for people to find providers that would accept the minimal amount Medicare would pay for these. Lastly, I feel the coverage options that are available from private insurance companies are vastly superior to the coverage Medicare would be able to provide.

Answer: Because plans are subject to change every year, this period is available so you can evaluate any changes in your current plan and network. You do need to make sure you review all providers to make sure any new plan will cover them. The plan benefits and costs should also be reviewed. Having a good agent you trust should avoid these situations where you end up in a plan that doesn't quite work the way you expected. However, agents are only human and therefore subject to making mistakes. Thankfully, there is a Medicare Advantage Open Enrollment Period that runs from January 1st - March 31st each year. During that period, you can make ONE change to a different plan. Essentially, this allows for any of these "mistakes" to be corrected without making you wait until the following year.

Answer: Medicare Supplement plans are generally the same from one company to the next. Personally, I suggest plans with companies that have a good history of reasonable rate increases and good customer service. When comparing the cost of Medicare Supplement plans to Medicare Advantage plans, the monthly costs can be significantly different. For some people, their healthcare needs are covered better with the supplement policy. Other folks are able to save money by having a lower premium advantage plan. Ultimately, it boils down to your personal preference on premiums and coverage as well as what your budget can afford.

Answer: When considering Medicare Part B, that depends on the insurance you have available through your employer (or your spouse's employer). Enrolling in Medicare may be less expensive, may provide more benefits, and may provide greater access to doctors. However, it may also be more expensive and may not be the right choice. You should compare the costs of enrolling in Medicare with the costs of staying on your group plan to see which makes the most sense for you.

For Medicare Part A, most people do not pay a premium and should go ahead and enroll when turning 65.

Answer: That all depends on which plan you choose. You may be able to keep your current doctors if you choose the right plan. However, you'll need to check to make sure each of your doctors is accepted by the plan. Sometimes, even in the same doctors office, only one or two doctors will accept a plan and the rest may not.

Answer: The easiest way to sort through the "mail mess" is to find a good agent that can help you. He or she will be able to explain the differences between the various plans and types of coverage. That way you can get rid of most of that annoying mail and any time you have a question, you can reach out to a real human being that you trust!

Answer: If you want the easiest and most flexible coverage, a Medicare Supplement policy will be a great option. With that you just need to make sure the provider you're using accepts Medicare. Another good option, if you prefer a Medicare Advantage plan, would be a PPO plan. This will allow you to see providers outside of your plan's network. However, you will want to choose the right plan to make sure your costs are not too high when using out of network providers.

Answer: I always recommend reaching out to your local assistance office to see what they might be able to offer you. Medicare Extra Help (Low Income Subsidy) is definitely a program I would recommend you look into. Depending on your state, you may have additional programs that you may qualify for. Finding a good agent will be your easiest route to finding these programs and getting enrolled if you're eligible.

Answer: This depends entirely on your own situation. I highly recommend speaking with your agent (or finding one to speak with) that will help you review your plan and preferences. Some years staying put is the right choice, and other years, changing is a must! A good agent will be able to help you evaluate which option is right for you.

Answer: Medicare Part D provides prescription coverage. This can be obtained through a stand alone plan that only offers drug coverage, or in a Medicare Advantage plan that also offers medical benefits. The main benefit of maintaining Part D coverage is avoiding a "Late Enrollment Penaly" later in life if you go without coverage for a period of time.

Answer: In both my personal and professional opinion, there are many reasons for seniors to work with a Medicare agent. A good agent might focus on one or two companies, but he or she should be able to offer you plans from multiple companies. The agent should also be able to offer you Medicare Supplement plans, Medicare Advantage plans, Prescription Drug plans, and ancillary plans for things like Dental, Vision, Hearing, Cancer, Critical Illness, and Hospital Indemnity. You might not need all of these, but your agent should be able to offer them and help you decide which ones will best fit your needs.

Once you have an agent, he or she will be able to provide the following:

1) Thorough and HONEST review of plan benefits and coverage.

2) Help understanding and choosing your options.

3) Help enrolling in the plan YOU choose.

4) Help throughout the year if you have ANY questions on medications, providers (networks), plan benefits, bills, etc.

5) Plan reviews during the Annual Enrollment Period each Fall.

Answer: Obviously, I am biased on this questions. However, in my personal and professional opinion, the only disadvantage is when you find the wrong agent. When working with a good agent, you will receive the following benefits:

1) Thorough and HONEST review of plan benefits and coverage.

2) Help understanding and choosing your options.

3) Help enrolling in the plan YOU choose.

4) Help throughout the year if you have ANY questions on medications, providers (networks), plan benefits, bills, etc.

5) Plan reviews during the Annual Enrollment Period each Fall.

Just make sure the agent you're working with is not just selling one or two plans. A good agent might focus on one or two, but he or she will be able to offer you plans from multiple companies. The agent should also be able to offer you Medicare Supplement plans, Medicare Advantage plans, Prescription Drug plans, and ancillary plans for things like Dental, Vision, Hearing, Cancer, Critical Illness, and Hospital Indemnity. You might not need all of these, but your agent should be able to offer them and help you decide which ones will best fit your needs.

Answer: Call centers are NOT exempt from this. However, they typically handle this as a verbal SOA. If you place an unscheduled phone call into an agent or call center, they are required to obtain the SOA via voice or electronic methods. CMS (Medicare) does require this form to be obtained before licensed agents may discuss plan benefits and details with you. In most in-person situations, Medicare requires the SOA to be signed at least 48-hours before the appointment.

Answer: Personally, I think the biggest mistake seniors make is trying to tackle the process on their own, or rely on advice from government agencies that are staffed by uncertified volunteers. I truly appreciate that these programs exist and I know the volunteers mean well. However, I have seen so many situations where they provided advice based on their own misunderstandings about how the different plans work. Generally, they are not licenses, certified, or even trained in the most expensive risks associated with coverage options. Not every licensed agent is a good option either. However, if you do some research and talk to other seniors you know, you can usually find a good agent to help point you in the right direction without trying to sell you the plans that pay him the most commission.

Answer: Medicare Advantage plans typically have a network of providers you must stay within. If you go out of network, you may pay higher amounts per service, or you may pay 100% of the charges. You also have to worry about whether or not the provider will bill your plan or make you pay up front and submit your own claims to your carrier. With a Medicare Supplement, Medicare is in the driver's seat. As long as the provider accepts Medicare, your supplement plan will pay its portion once Medicare processes the claim.

Answer: I love helping seniors understand and enroll in their options for Medicare coverage. There are so many ins-and-outs to the coverages that are available, it's overwhelming for most. Being able to see the relief in their faces when they begin to understand and have a peace about their decision is priceless!

Answer: Medigap Plan G covers 100% of all remaining Medicare-approved charges once you have paid your annual deductible for Part B. If you have already paid your deductible for the year, and you receive any bills, I strongly recommend contacting the billing department and making sure they billed Medicare & your medigap company. Generally, Medicare sends the claim information to the medigap company automatically. However, I find it's usually a good idea to make sure they have all of the applicable billing information for you.

Answer: Medicare as a whole operates on a "medically necessary" basis. If your blood tests are considered medically necessary, they are typically covered under Part B. However, if you receive blood test that are considered "elective", they are not likely to be covered. These would include situations where you might be required to have blood tests for employment purposes.

Answer: Medicare allows a few scenarios where you can wait to sign up for Part B or Part D. For example, if you or a spouse is working and has coverage available from an employer, you may be able to stay on the plan and wait to enroll in Part B, and/or Part D. However, if you do not have "credible" (coverage as good as or better than Medicare) coverage and you do not sign up for Medicare Part B or Part D when you first become eligible, you will pay penalty amounts once you do sign up.

Answer: No, outpatient surgeries, when medically necessary, are covered under Part B. Part A helps cover inpatient stays, skilled nursing facility stays (for skilled level care), and hospice.

Answer: Medication costs to the pharmacy are subject to change. Depending on your Part D plan, you may end up paying more if the pharmacy has to increase their charge in response to the price they had to pay to their supplier. Also, if your pharmacy network changes (although uncommon), that could also change what you're being charged.

Answer: Annuities can play a tremendous role in retirement planning. If you have all of your money in the market, you're susceptible to market losses. Simply put, you can lose your hard earned savings. Also, if you keep your money in the bank, you typically earn very little interest. Thus, annuities can help protect your money, pass more easily to your beneficiaries, and still allow your money to grow without the risk of losing your principle.

Answer: Perhaps. If you're in a "season" where you have frequent health needs, you will certainly pay more out-of-pocket costs. However, if your year-after-year health is consistently healthy, you may still spend less with your Medicare Advantage plan. That being said, if your health is costing you high copays and you anticipate continued healthcare needs, you may want to consider switching to a Medigap policy if you're able. Either way, you're going to pay, you just have to decide which way fits your needs best.

Answer: Typically, yes, you will need to answer health questions when switching from one Medigap plan to another. There are some insurance companies that allow you to upgrade to a more comprehensive plan (with that same company) without answering health questions. Others may allow you to downgrade to a less comprehensive plan. However, if you are changing to another company, you will likely need to answer those. The exceptions to this would be if you live in a state that allows you to change companies and/or plans without health questions. Generally this must be done near your birthday.

Answer: For now, there are only 7 apps that are eligible under Medicare. However, coverage generally requires a prescription and an unusual billing process that involves the providers instead of pharmacies. Sadly, these hurdles will likely cause more roadblocks to getting help paying for digital therapeutics.

That being said, the 7 apps currently eligible are:

1) SleepioRx for insomnia 2)Daylight for anxiety 3) Rejoyn for depression 4) reSET for substance use disorder 5) reSET-O for opioid use disorder 6) Somryst for chronic insomnia 7) MamaLift Plus for maternal mental health

Answer: For seniors that use expensive medications, this will likely reduce their costs as they will only pay $2,000 for covered medications. Depending on plan availability, some seniors will pay more in monthly premiums than in previous years. That's because the insurance companies have to offset the cost of the lower maximum. For others that generally only use few, inexpensive, generic medications, they'll not likely see much difference.

Answer: Original Medicare does not cover hearing aids. You will either pay out-of-pocket or use a separate hearing insurance policy. However, some Medicare Advantage plans do offer coverage of hearing aids. The benefit amounts and types of aids vary by plan.

Answer: The premium is the amount you pay every month for your insurance. Medicare Part B premiums are withheld from your Social Security benefit. If you have a Medicare Supplement policy or a Medicare Advantage plan, you may have an additional premium. When you need services, you must first pay your deductible amount to the provider(s) (unless your plan has a $0 deductible). Once you have paid that amount, you generally have a copay amount payable for each service. Some services will require a coinsurance percentage instead of a flat copay amount. Generally, the coinsurance is 20% and those are applied to services like Durable Medical Equipment, Medicare Part B covered medications (IV, Infusions, etc.), Diabetic supplies, etc.

Answer: No, you cannot be dropped because of a health condition. In fact, your premium cannot be changed because of your specific health reasons either.

Answer: Your health should not change your Medicare plan. However, you should review your plan options to make sure your plan will adequately cover the health needs of your new condition.

Answer: This depends entirely on your age and current insurance situation. If you are already eligible (or will be eligible upon your retirement date), you will need to verify your enrollment in Medicare. This will be automatic if you're also receiving Social Security income. However, if you are not yet receiving SS retirement income, you will need to actively apply for Medicare by contacting Social Security. You will also want to make sure you have your new Medicare Advantage plan, or Medigap plan applied for prior to your work insurance being terminated.

Answer: If the following criteria is met, Medicare will likely cover the services: The care is medically necessary; The cruise ship is in U.S. waters (within six hours of a U.S. port) when you receive the care; The doctor providing care is legally allowed to provide medical services on a cruise ship.

Outside of that, Medicare generally does not cover health services while onboard a cruise ship.

Medicare Supplement (Medigap) policies and Medicare Advantage plans may help cover those expenses. Separate travel insurance policies may also be purchased to cover health services while onboard a cruise ship or in a foreign country.

Answer: In some ways, yes, and in other ways, no. For many people, Medigap (Medicare Supplement) policies are not affordable. Staying with regular Medicare without a supplement is not appealing because of the potential out of pocket costs associated with your health needs. MA plans do offer a maximum amount you can pay each year, as well as smaller co-pays for more common, less expensive services, as well as additional benefits not offered by Medicare. That being said, regular Medicare is very user friendly and when combined with a Medigap policy is a very comprehensive medical coverage. With more people choosing MA plans, that is likely to increase the costs of Medigap policies making them less affordable for even more seniors.

Answer: In short, Medicare Advantage plans cover the same services as regular Medicare. However, the amount you pay for services may be higher or lower than regular Medicare. In addition, the MA plans may offer additional benefits not covered by Medicare, such as routine Dental, Vision, Hearing, and more. The way the plans operate are also different. With MA plans, you generally have a network of providers to use, while regular Medicare allows you to use any doctor that accepts Medicare. Your personal preferences on out of pocket costs vs monthly premiums will play a large roll in helping you decide which type of coverage will best meet your needs.

Answer: Medicare coverage is generally based on medical necessity (as determined by CMS). Unfortunately, only the Monofocal lenses are deemed medically necessary and the other lenses, such as multifocal, toric, EDOF, and LAL are considered NOT medically necessary and are therefore, not covered by Medicare. As such, most insurance companies follow this same rule of thumb and also cover only the monofocal lenses.

Answer: The 3-midnight rule is a common requirement that a plan member be admitted as an in-patient in a hospital for 3 full days (3 overnights) before being transferred to a Skilled Nursing Facility. In most cases, the plan will not cover the SNF stay if the plan member did not satisfy this (and other) requirements.